191222261-5-12-2022-31-AS-CHAS-CETMZS-20220527100338

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191222261
Report Date: 05/12/2022
Date Signed: 05/12/2022 10:59:19 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/04/2022 and conducted by Evaluator Tuesday Cabiness

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20220504150715

FACILITY NAME:	TRUDEZ HOME CARE		FACILITY NUMBER:	191222261
ADMINISTRATOR:	LOPEZ, WALDITRUDEZ P.		FACILITY TYPE:	740
ADDRESS:	15516 EL CAJON ST.		TELEPHONE:	(818) 336-6537
CITY:	SYLMAR	STATE: CA	ZIP CODE:	91342
CAPACITY:	6	CENSUS: 5	DATE:	05/12/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Eileen Calderon		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Facility are not following COVID-19 protocols

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tuesday Cabiness conducted an unannounced complaint investigation for the allegation mentioned above. The following was determined:

It was alleged that Covid-19 protocols are not being followed at the facility. Upon arriving, LPA observed COVID signs and procedures posted on the front door. LPA rang the door bell, and caregiver Christina Calderon allowed LPA to enter. Upon entering, LPA was not screened and temperature was not taken. From 930am to 11am, a physical plant tour, and interviews were conducted with staff and the Administrator, who was not present at the time of the visit. Caregiver Eileen contacted the Administrator Waldi Trudez, and everyone was informed the reason of the visit. LPA observed the front cleaning station at the front door, and reviewed the sign in sheet, in which dates and signatures were current. LPA also observed only (1) staff wearing a mask inside the facility. Interviews revealed the facility does not keep the

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20220504150715

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: TRUDEZ HOME CARE	FACILITY NUMBER: 191222261
	VISIT DATE: 05/12/2022

NARRATIVE

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thermometer at the front door, due to a resident taking it from the front table and hiding it from the staff. Administrator informed LPA that they have to keep it locked up. As far as staff wearing mask, the Administrator informed LPA that staff are to wear them, but does not all day. LPA gave suggestions to the Administrator on how to implement better COVID procedures for the facility and staff. Administrator informed LPA that the facility will do better with COVID procedures. This poses a potential health and safety risk to residents in care. Therefore, the allegation "Facility are not following COVID-19 protocols" is SUBSTANTIATED at this time.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20220504150715

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: TRUDEZ HOME CARE	FACILITY NUMBER: 191222261
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/12/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/26/2022 Section Cited CCR 87470(a)	1 2 3 4 5 6 7	Infection Control Requirements:(a) A licensee shall ensure that infection control practices are maintained as follows:: This requirement was not followed, evidenced by: based on today's visit, staff did not properly	1 2 3 4 5 6 7	Administrator will read the regulation on Infection Control Requirements and submit a statement that it was read and will agree with a signature that COVID procedures will be implemented properly.
	8 9 10 11 12 13 14	screen LPA before entering the facility and only (1) staff was wearing a mask. This poses a potential health and safety risk to residents in care.	8 9 10 11 12 13 14	Document needs to be submitted to LPA by POC date.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC9099 (FAS) - (06/04)

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